NJ Lawmakers Press Ahead with Mental Health Service Reform

Some legislators, who initially were uneasy about process to consolidate oversight of behavioral and physical health programs, now look to build on the change

New Jersey lawmakers, including some who initially raised concerns about the move, are going forward with a plan to build on an administrative reform that consolidated state oversight of behavioral and physical health programs to create more integrated healthcare services.

The state Senate approved bipartisan legislation in December that would codify aspects of the shift and have the Department of Health, which now operates the Division of Mental Health and Addiction Services, create a single license process that would enable qualified facilities to offer treatments to address mental illness, addiction, and physical maladies. The bill would also permit these services to be administered in “shared spaces,” something now largely prohibited by state regulation and often blamed as a barrier to more comprehensive care.

Oversight of behavioral and physical health systems had been bifurcated in the past, making it harder for providers to offer a range of services and creating challenges for patients who might need help with both depression and high blood pressure, for example. A growing body of research suggests integrated care helps patients improve their whole health, while saving money. A unified licensing system has been flagged as a key element in New Jersey’s reform.

The proposal (S-1710), an amended version of a bill championed by longtime health committee chairman Sen. Joseph Vitale (D-Middlesex), has been debated for more than three years; it still requires final approval in the state Assembly, which has only a few scheduled meetings remaining before the legislative session ends next week.

As of Tuesday, the list of items to be considered during Thursday’s Assembly meeting did not include the Senate version or its Assembly counterpart, led by Assemblyman Vincent Mazzeo (D-Atlantic) and Assemblywoman Valerie Vainieri Huttle (D-Bergen), among others. Senator Robert Singer (R-Ocean), a former hospital executive, and Assemblywoman Nancy Munoz (R-Union), a nurse, are among the bills’ sponsors.

Eliminating ‘unnecessary barriers’

"In order to broaden access to quality care for patients across New Jersey, eliminating the requirement for facilities to get multiple licenses for behavioral health services and ambulatory (or physical) care is a necessary step to take," Vitale said. “We must endeavor to eliminate unnecessary barriers to improve integrated health care services and this legislation will do that."

Renewed attention to the legislation comes shortly after DMHAS — which previously was under the Department of Human Services — settled into its new home this fall as part of the recently created Integrated Services branch of the health department. One of the largest government divisions, DMHAS — with 4,300 employees and a $1.16 billion budget — runs the state’s four psychiatric hospitals and oversees an extensive network of community-based services that assist tens of thousands of Garden State residents.

The DOH announced in December that an 18-member integrated-health advisory committee had been assembled to “assist in creating a patient-centered system of care that includes prevention, wellness, treatment, and sustained recovery through coordinated care,” and had held its initial meeting. The department also solicited input during the fall through a series of 21 county-based town hall meetings and conference calls with some 1,500 providers and other stakeholders.

“Now the focus can shift to creating a system of care that treats physical illness, mental health care, and substance use disorder equally, and in a coordinated fashion,” acting health commissioner Christopher Rinn said.

Christie caused controversy

Gov. Chris Christie sparked controversy when he first proposed the transfer in late June, amid the chaos of last-minute budget negotiations, and gave lawmakers the rest of the summer to block the reform. The reorganization proposal was based in a large part on a 2016 report from Seton Hall professor John Jacobi that identified certain bureaucratic and historic hurdles that were preventing New Jersey from moving to a more integrated system of care. (Among Jacobi’s top recommendations was to create a single licensing system.)

The surprise move prompted Vitale and Vainieri Huttle, who chairs the Assembly Human Services committee, to hold joint hearings on the proposal in late July. Both Vainieri Huttle and Vitale, who has worked for years to streamline healthcare licensing, said they applauded the Republican governor’s goals but had concerns about the timing of his proposal and the process for making such significant changes.

Advocates for individuals with disabilities and mental illness were among those who testified, warning that the DMHAS shift, while well intended, could trigger new problems. They also worried about the impact on community-based providers, who are already experiencing a major change in how they are reimbursed by the state for Medicaid services.

Many said that even if the reform would prove beneficial, the timing was off, since Christie will be leaving office later this month when Gov.-elect Phil Murphy, a Democrat, takes the helm. But Democratic lawmakers were unable to build enough support to block the move in advance of the August deadline Christie imposed.

As the move proceeded, lawmakers refocused on the licensing legislation, which had essentially remained dormant since February. Vitale updated his version to include references to the reform plan and added language that directs the DOH to develop a system to provide a single license to permit facilities to offer a range of behavioral and physical health services. Under the bill, the new system must permit providers to use a single facility for both types of care, something that was largely prohibited in the past, making it hard to truly integrate care.